Saturday, May 29, 2010

More of "You Don't Have to be a Brain Surgeon to Know That..."

Here's the next item:
After opening, refrigerate products that say "refrigerate after opening."

Following simple instructions can lead to the successful avoidance of major aggravations down the line. Going to the kitchen cabinet and opening pasta sauce only to find a science experiment is not conducive to a hearty appetite (and scraping off the mold does not make it safer for consumption.)

Wednesday, May 26, 2010

Bono's Back Surgery

U2 front-man, Bono, suffered a herniated lumbar disc and underwent surgery to remove the extruded disc fragment, according to his German neurosurgeons. This is a common operation but is not done emergently unless nerves in the spine are severely compressed leading to either profound muscle weakness such as a complete foot drop or abrupt bladder and bowel dysfunction accompanied by weakness and numbness in both legs. The later is know as cauda equina syndrome. When one of these two conditions occurs, emergent surgery is recommended to prevent permanent nerve damage. A full recovery is generally expected. When the primary symptom is pain and mild weakness of a muscle as well as some numbness is present, then non-surgical treatment is generally initiated first. This is the more common scenario and with time, the herniated disc generally shrinks and can be resorbed, resulting in resolution of symptoms without surgery. When symptoms do not resolve or when the situation is emergent, than a procedure called a discectomy is performed. This can be done via a "standard" laminectomy in which an approximately three inch incisicion is made in the center of the lower back, muscle is stripped off the spine, a portion of the spine know as the lamina is removed to enter the spine and then the disc fragment is removed. This can also be performed via a microdiscectomy in which the incision is smaller and the amount of bone removal is less and a microscope is used to visualize the inside of the spinal canal and the disc fragment. The procedure I prefer is even less invasive, what is refered to as an endoscopic microdiscectomy. With this technique a two centimeter (less than half inch) incision is made and a tube is passed to the spine without needing to dissect muscle off the spine. A few slivers of lamina are removed, if any, and the spinal canal is able to be visualized through the tube using high-power magnification. The fragment is then visualized and removed. The operation is performed under general anesthesia and the patient is able to go home the same day. Patients are walking the same day, begin therapy within a week and can resume the majority of their normal life-style activities within four to six weeks. The surgery is highly effective in resolving the symptoms and has a success rate of over 95%. A herniated disc can reherniate and this occurs between 10 and 20% of the time. Learning proper back care and maintaining good core muscle strength helps reduce the incidence of reherniation. This is the link to the video of this type of operation:

Saturday, May 22, 2010

You Don't Have to be a Brain Surgeon to Know That...

This is the beginning of a new feature in which I hope many will participate. As a brain surgeon, the phrase "you don't have to be a brain surgeon to know that..." has particular resonance for me. The second half of the statement is generally something that it is assumed any fool should know. The implication of the first part of the statement is that there are things that are so esoteric or complex only an individual blessed with a prodigious intellect could comprehend them. Well, when it comes to brain surgeons, the truth of the matter is that though we do study and train for years, rigorously, a great deal of what we need to know on a day to day basis is a matter of common-sense. The majority of the knowledge we utilize daily is knowledge that most people possess. What is truly remarkable is how often we human beings forget the simple truths that are so often fundamental to our well-being and success. Why people do not utilize the knowledge they possess is an interesting question to which I don't have the answer. Perhaps part of the answer lies in people's unwillingness to expend the mental energy required to understand the basics of a sitiuatuion they may find themselves in. When one does make a effort one often finds that the solution to a predicament often follows or better yet, keeps a person from falling into a predicament in the first place. Ultimaletly, with less predicaments, we have more time for contentment and pleasure in life.

So, in an effort to provide some simple insight I will begin cataloging some of those things that all should know but all tend to disregard at one time or another. I would be delighted if you would send in your items which you feel should be included in such a list.

My first entry is: If you are going to be far from a toilet for a while and you think you have to go, go.

Uncomfortable, embarrassing, all-consuming, and, oh yeah, very uncomfortable are some of the words that come to mind when you really have to go to the bathroom and one is not available. It is truly amazing how often we find ourselves in this situation even after our parents have warned us. Just think about it again for a moment before you get into a car for a ride that will take longer than fifteen minutes.

Friday, May 14, 2010

Extraforaminal Endoscopic Lumbar Microdiscectomy

Click on this link to see the video of an endoscopic lumbar microdiscectomy I performed: Hope you find it interesting. Please share your thoughts with me.

Tuesday, May 11, 2010

Doctors opt out of Medicare

Here is the youtube link to the piece I did for CNNMoney. I would greatly appreciate your comments (thoughtfully articulated.)

Monday, May 10, 2010


I'm so happy to announce that this blog is now linked to, the website for my radio show, BackTalkLive. The website will shortly become as soon as the domain transfer is completed. Please listen into the radio show on WOR710am on Sunday nights at 7:30 PM. You can get it as a streaming podcast on I would love to hear your thoughts about the show. This past Sunday, Dr. Vijay Vad was our guest. He, along with Richard "Mr.Chipwich" Lamotta developed a terrific analgesic cream that really does work (not a magic potion), The MDsystem. Please check out their website, Dr. Vad, a sports medicine doctor at Hospital for Special Surgery will be on "The View" this week.